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12 April 2019 : Case report  Saudi Arabia

IgA Nephropathy Flare-Up Mimicking Staphylococcus Post-Infection Glomerulonephritis in Patient with Staphylococcus Aureus Infection Treated with Cefazolin: A Case Report and Brief Review of the Literature

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction , Rare disease, Clinical situation which can not be reproduced for ethical reasons

Hajar AlQahtani12ABCDEF*, Fulwah Y. Alqahtani3EF, Fadilah S. Aleanizy3EF, Saeed Baloch4EF, Deanne Tabb2EF

DOI: 10.12659/AJCR.914935

Am J Case Rep 2019; 20:508-510

Abstract

BACKGROUND: Glomerulonephritis (GN) associated with post staphylococcus infection (PSIGN) and high serum immunoglobulin A (IgA) has been reported recently. Patients with GN after infection with underlying IgA nephropathy create a challenge to determine the etiology of GN. Therefore, treatment should be accordingly, with steroids used if the IgA nephropathy flare-up is determined to be the etiology. The aim of this case report was to shed light on the difference between PSIGN and IgA nephropathy flare-ups in patients with a history of IgA nephropathy, and how to treat patient cases accordingly.

CASE REPORT: An 81-year-old male presented to our Emergency Department complaining of increasing pain, swelling, and redness of his left knee since 2 days ago. He had a history of recent methicillin sensitive Staphylococcus aureus (MSSA) left knee arthroplasty infection that was treated with cefazolin, and he had a history of IgA nephropathy diagnosed 1 year ago.

CONCLUSIONS: In our patient case, renal biopsy studies were not enough to differentiate between PSIGN and IgA nephropathy flare-ups, thus, clinical presentation was important. PSIGN was found to have a delayed onset compared to IgA nephropathy. Lower serum complement 3 (C3) level, heavier proteinuria, and acute renal failure are common with PSIGN compared to IgA nephropathy. Identifying the etiology and treating our patient accordingly with immunosuppressive therapy had a positive impact on the patient, restoring renal function without further damage.

Keywords: Glomerulonephritis, IGA, Staphylococcus aureus, Vasculitis, Aged, 80 and over, Anti-Bacterial Agents, Cefazolin, Diagnosis, Differential, Glomerulonephritis, Staphylococcal Infections

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923